IRON ASSASSIN'S DEMO DERBY
Event Timing: April 4th, 2020
Event Address: 33800 King Rd Abbotsford BC,
Contact us at 778-347-1159, Email: Demoderby100@gmail.com
Email address *
FIRST & LAST NAME *
FULL ADDRESS & PHONE # *
CLASSES COMPETING IN *
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VEHICLE INFO (YR, MAKE, MODEL, ENGINE) *
VEHICLE # *
PASSENGER NAME *
SPONSOR INFO *
SMALL CAR TEAM MATE NAME, #, TEAM NAME *
ACCOMPLISHMENTS (TELL US ABOUT YOU) *
EMERGENCY CONTACT NAME # *
TOTAL PAYMENT: make payment by e-transfer to demoderby100@gmail.com, question demo, answer derby1 . CHECK PAYABLE TO LEE PEMBLE *
YOU MUST NOTE YOUR BANK CONFIRMATION # ON THIS FORM, OR MAIL CHECK TO PO Box 824 Abbotsford B.C. Canada V2T 7A2 AND INCLUDE YOUR CHECK # ON THIS FORM (BELOW NOTE PAYMENT TYPE)
BANK E-TRANSFER CONFIRMATION # OR CHECK # *
BY REGISTERING YOU AGREE TO SEND PAYMENT ASAP, ACKNOWLEDGE TO NO MINORS UNDER 14, NO ALCOHOL OR ILLEGAL DRUGS ALLOWED IN PITS OR COMPETITION AREA *
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